The Primacy of the Low Carbohydrate Diet - part 1 of 2

chalem_laurence_134_01By Laurence D. Chalem

In my book Essential Diabetes Leadership (2010), I present the hypothesis and proof that a ketogenic (high fat, medium protein, low-carbohydrate) diet for diabetics, as part of an overall blood glucose optimization model, supports a long, happy, healthy life.

I included specifics from six of the twelve total systems: the (1) circulatory, (2) digestive, (3) endocrine, (4) excretory, (5) nervous, (6a) skeletal (teeth), and (7a) integumentary (gingiva: the gums).

Regarding the nervous system, which includes the sense organs and vestibular system, the last endnote of the "Epilogue" provided supporting evidence for the use of a ketogenic diet in the successful treatment of epilepsy. Since there's more to the nervous system, and to the diseases of, than forty different kinds of epilepsy, I'll suggest a couple other information sources.

Reminiscent of Dr. Weston Price, we find a brave treatise written by another dentist. First published in 2001, then condensed in 2005, Alzheimer's Solved, by Dr. Henry Lorin, proffers a thoroughly researched theorem - his book references over 2,500 scientific articles - that better explains the data and observations than any other work on the subject: "It is indeed possible for a person to have blood cholesterol levels that are too low." Reading through his manuscript, that conclusion is inescapable.

From aging to xanthomas, Dr. Lorin's theorem in Alzheimer's Solved unifies seemingly diverse conditions such as AIDS, Alzheimer's disease, brain surgery, Cushing's disease, dementia, depression, Down syndrome, epilepsy, head injury, HIV, osteoporosis, Parkinson's disease, vasculitis, and others, with his remarkably simple deduction that amyloid-beta amyloid plaques "is the body's temporary substitute for cholesterol molecules."

Amyloid is to be used as a short-term ‘bandage' for cell membranes until more cholesterol is provided." Should that cholesterol, for whatever reason, be withheld, nearly all the aforementioned diseases inevitably become terminal. Dr. Lorin summarizes his diet-beyond important micronutrients such as vitamin D-quite eloquently in one sentence: "The easiest and most natural way to do this [preventing and treating most of the described diseases] is by eating foods that contain cholesterol, while minimizing the consumption of foods that are primarily carbohydrates (starches)."

You may also be interested in reading The Brain Trust Program (2007), by Larry McCleary, MD, which accessibly describes the important component parts of the nervous system, then delivers a striking contrast to all the also-ran diet-brain books published on how to best support them through diet. Although he doesn't outright advocate a low-carbohydrate diet, his 7-day menu plan sure does resemble one. A person with diabetes would simply need to skimp further on the fruit and minimal multigrain bread and crackers mentioned.

Here I could discuss the (8) muscular system in detail, but so much data exists on low-carbohydrate diets and exercise physiology, overlapping some with the (9) respiratory system - and I reprinted with permission much of the material written by Professor Emeritus Robert S. Horn on the subject in my first book-that, although tempting, I shall not rehearse the subject here, other than to say that Stephen D. Phinney provides great additional insight.

In "Ketogenic Diets and Physical Performance," which contains many good sources for further reading, Dr. Phinney states in the Abstract that "impaired physical performance is a common but not obligate result of a low carbohydrate diet. Lessons from traditional Inuit culture indicate that time for adaptation, optimized sodium and potassium nutriture, and constraint of protein to 15-25 % of daily energy expenditure allow unimpaired endurance performance despite nutritional ketosis."

And he concludes: "Both observational and prospectively designed studies support the conclusion that submaximal endurance performance can be sustained despite the virtual exclusion of carbohydrate from the human diet. Clearly this result does not automatically follow the casual implementation of dietary carbohydrate restriction, however, as careful attention to time for keto-adaptation, mineral nutriture, and constraint of the daily protein dose is required. Contradictory results in the scientific literature can be explained by the lack of attention to these lessons learned (and for the most part now forgotten) by the cultures that traditionally lived by hunting. Therapeutic use of ketogenic diets should not require constraint of most forms of physical labor or recreational activity, with the one caveat that anaerobic (i.e., weight lifting or sprint) performance is limited by the low muscle glycogen levels induced by a ketogenic diet, and this would strongly discourage its use under most conditions of competitive athletics."

If you were thinking that I would now go over each of remaining five human organ systems (five because I'm including the skeletal system proper, the bones, and the integumentary system proper, the skin, hair and nails), I have a shocker for you: the medical literature world is predominantly data and theorem light (more, ignorant) about how macronutrients, not just vitamins and minerals, but how macronutrients (fats, proteins, and carbohydrates) and, specifically, a low-carbohydrate, medium-protein, high-fat diet, affect all but one of the remaining systems.

True, we know how the use of sugar per se affects nearly every organ system; two accessible books on the subject that you may find interesting are Lick the Sugar Habit (2001) and Suicide by Sugar (2009), both by Nancy Appleton, PhD. It appears that carbohydrates have been considered essential since the dawn of agriculture. For example, in The Third Chimpanzee: The Evolution and Future of the Human Animal, Jared Diamond writes:

"That transition from hunting and gathering to agriculture is generally considered a decisive step in our progress, when we at last acquired the stable food supply and leisure time prerequisite to the great accomplishments of modern civilization. In fact, careful examination of that transition suggests another conclusion: for most people the transition brought infectious diseases, malnutrition, and a shorter life span. For human society in general it worsened the relative lot of women and introduced class-based inequality. More than any other milestone along the path from chimpanzeehood to humanity, agriculture inextricably combines causes of our rise and our fall."

Back to organ systems. As I was saying, we know how sugar by itself negatively affects many organs and organ systems, but little is known about how any specific diet permutation affects the (7b) integumentary (skin, hair and nails), (9) respiratory, (10) lymphatic, (11) immune, or (12) reproductive system. Now, it surely can be inferred that, if we forgo the bolus insulin and carbohydrates, and eat just fat and protein, with type 1s only adding basal insulin, and we live a long, happy, healthy life, then all other organ systems must be doing just fine. But such circumstantial evidence doesn't necessarily prove that they're healthy in the court of public opinion, let alone in science.

There is some information about how diet affects the (12) reproductive system, but most sources highlight the role of calories, not how any specific combination of macronutrients affects the reproductive system. At first glance, learning that a low-carbohydrate, ketogenic diet led to significant improvement in weight, percent free testosterone, and fasting insulin in women with obesity and Polycystic Ovary Syndrome (PCOS) over a 24 week period, it sounds like we can put one in the win column for a low-carbohydrate diet best supporting the reproductive system. Alas, PCOS is considered an endocrine disorder.

Which really leaves only one organ system that I didn't cover. Well, half of one.

The Primacy of the Low Carbohydrate Diet part 2

Laurence D. Chalem (b. 1963), a type 1 diabetic, has been passionately researching diabetes for the last decade. In his most recent book, Essential Diabetes Leadership, Laurence investigates the literature of the last three centuries in search of an optimal treatment of diabetes.

August 2011

1. "Whether diet may influence autoimmunity has been the subject of many unsolved debates. Interestingly, growing evidence indicates a large overlap between the mechanisms controlling tolerance to dietary antigens and autoimmunity. See "Autoimmunity and Diet," by Cerf-Bensussan N. Nestle Nutr Workshop Ser Pediatr Program. 2009;64:91-9; discussion 99-104, 251-7.
Available online at Retrieved on 12/11/09.

The use of omega-3 polyunsaturated fat-fish oil-has been known in small doses to aid the immune system. See "Dietary Fatty Acids and the Immune System," by Calder PC. Lipids 1999; 34:S137-S140. Available online at Retrieved on 12/13/09.

4. See "The Effects of a Low-Carbohydrate, Ketogenic Diet on the Polycystic Ovary Syndrome: A Pilot Study," by John C Mavropoulos, William S Yancy, Juanita Hepburn, and Eric C Westman. Nutrition & Metabolism 2005, 2:35. doi: 10.1186/1743-7075-2-35. Available online at Retrieved on 12/10/09.

5. See "The Effect of a Low-Carbohydrate Diet on Bone Turnover," by J. D. Carter, F. B. Vasey, and J. Valeriano. Osteoporos Int (2006) 17: 1398-1403. doi: 10.1007/s00198-006-0134-x. Available online at Retrieved on 12/10/09.

6. See "Food Groups and Bone Health," by Susan A. New. In: Nutrition and Bone Health. Edited by M.F. Holick and B. Dawson-Hughes. New Jersey: Humana Press Inc., 2004.

7. For a summary of the issues involved, see "Toward A Policy Agenda On Medical Research Funding: Results Of A Symposium," by Robert I. Field, Barbara J. Plager, Rebecca A. Baranowski, Mary Anne Healy and Margaret L. Longacre. Health Affairs, 22, no. 3 (2003): 224-230. doi: 10.1377/hlthaff.22.3.224. Available online at Retrieved on 12/13/09.

8. See "Sodium, Potassium, Phosphorous, and Magnesium," by Robert P. Heany. In: Nutrition and Bone Health. Edited by M.F. Holick and B. Dawson-Hughes. New Jersey: Humana Press Inc., 2004, p. 327.

9. See "Calcium and Vitamin D for Bone Health in Adults," by Bess Dawson-Hughes. In: Nutrition and Bone Health. Edited by M.F. Holick and B. Dawson-Hughes. New Jersey: Humana Press Inc., 2004, p. 197.

10. See "Vitamin A and Bone Health," by Peter Burckhardt. In: Nutrition and Bone Health. Edited by M.F. Holick and B. Dawson-Hughes. New Jersey: Humana Press Inc., 2004.

11. See "Fluoride and Bone Health," by Johann D. Ringe. In: Nutrition and Bone Health. Edited by M.F. Holick and B. Dawson-Hughes. New Jersey: Humana Press Inc., 2004, p.345.

12. See "Food Groups and Bone Health," by Susan A. New. In: Nutrition and Bone Health. Edited by M.F. Holick and B. Dawson-Hughes. New Jersey: Humana Press Inc., 2004, p. 237.

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